Healthcare Provider Details

I. General information

NPI: 1104511138
Provider Name (Legal Business Name): MARIA K ITTYCHERI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2023
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 MEADOW VIEW DR
SHAWNEE KS
66227-7288
US

IV. Provider business mailing address

5675 ROE BLVD STE 100
ROELAND PARK KS
66205-2538
US

V. Phone/Fax

Practice location:
  • Phone: 913-601-4500
  • Fax:
Mailing address:
  • Phone: 913-432-2080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number05-53283
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: